Rickettsioses diagnosis at early stage is often difficult because early signs and symptoms are usually nonspecific. However, most physicians adopt some clinical clues that help them to detect early tick-borne rickettsial disease and differentiate it from similar illnesses. These include clinical history, such as questions about tick bites, exposure to tick habitats, recent travel, and close contact with pets and signs and symptoms of disease. Generally, the clinical symptoms of tick-borne spotted fever group rickettsioses begin 4 to 10 days after a bite and typically include fever, headache, muscle pain, rash, local lymphadenopathy, and, for most of these diseases, a characteristic inoculation eschar at the bite site. However, these signs vary
